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[Equipment] Help With S9 VPAP Auto Settings
#1
Can someone help me with the settings for my newly-acquired ResMed S9 VPAP Auto? (Yes, as I type the words I tingle with pride that I've finally been able to get my grubby little hands on one of these delights!)

First some history. I was titrated at a pressure of 13. Aerophagia caused a quick switch from a CPAP at 13 to a fixed BiPAP at 13/8. Elevated CA index resulted in a drop to 11/8 and then 10/7. This all happened during November and December of 2011.

Since then I've been doing my own tweaking and discovered the following based on leaving the settings alone for a period of at least 30 days and evaluating. I won't go over the details of all the different settings I tried, but I discovered that a straight CPAP pressure of 11 is all I can handle without swallowing air, and it will keep my AHI under 3. Since I still have frequent awakenings, trouble falling asleep, and trouble staying asleep I want to try to do better and my doctor thinks that lowering my AHI even further may help in that regard. I've noticed that I can go with a pressure as low as 10 and my AHI doesn't go much above 3.

I had finally settled on the following settings for my fixed-pressure PRS1 BiPAP 650P and they've been there for about a year or so:

IPAP = 12,
EPAP = 9,
Bi-Flex = 3.

At these settings I still swallow air on some nights, but not on most nights. My 7-day and 30-day AHI averages stay between 1.5 and 2.5, with a single night's AHI never (or maybe rarely) rising above 3.

So I'm thinking of the following settings for the VPAP Auto:

min EPAP = 4
max IPAP = 13
PS = 6

This will allow me to maintain the difference in pressure of 6 that I currently have with the PRS1 (IPAP - EPAP + BiFlex = 12 - 9 + 3 = 6) and allow the IPAP to float between 10 and 13. Hopefully it won't go above 12 too often, and may stay down closer to 11.

The goal of course is to prevent aerophagia as much as possible and lower my AHI.


Sleepster
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#2
(06-28-2014, 04:12 PM)Sleepster Wrote: So I'm thinking of the following settings for the VPAP Auto:

min EPAP = 4
max IPAP = 13
PS = 6

This will allow me to maintain the difference in pressure of 6 that I currently have with the PRS1 (IPAP - EPAP + BiFlex = 12 - 9 + 3 = 6) and allow the IPAP to float between 10 and 13. Hopefully it won't go above 12 too often, and may stay down closer to 11.

The goal of course is to prevent aerophagia as much as possible and lower my AHI.

I *really* believe you're mistaken about how biflex works, though I'm trying to find some documentation on it. it's *not* like epr in the non vpap models from resmed, which is just a straight extra pressure reduction between inhalation.

are you looking to go with S mode or vauto mode?

4 is a VERY low epap, I predict trouble.
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#3
everything I've found indicates that biflex (cflex/aflex) do *not* present a specific drop in pressure, unlike EPR, which is 1, 2, or 3cm drop from set pressure between inhalation.

xflex smooths the curves in varying amounts, taking into account how large your breaths are, on a breath by breath basis, vagueness here: http://bipapautomseries.respironics.eu/

video showing differing amounts of pressure manipulation depending on size of breath:

https://www.youtube.com/watch?v=S-LD5kpUxDk
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#4
(06-28-2014, 04:12 PM)Sleepster Wrote: IPAP = 12,
EPAP = 9,
Bi-Flex = 3.

At these settings I still swallow air on some nights, but not on most nights. My 7-day and 30-day AHI averages stay between 1.5 and 2.5, with a single night's AHI never (or maybe rarely) rising above 3.

So I'm thinking of the following settings for the VPAP Auto:

min EPAP = 4
max IPAP = 13
PS = 6

This will allow me to maintain the difference in pressure of 6 that I currently have with the PRS1 (IPAP - EPAP + BiFlex = 12 - 9 + 3 = 6) and allow the IPAP to float between 10 and 13. Hopefully it won't go above 12 too often, and may stay down closer to 11.

my *guess* is that you'd probably do better with a min epap of 6, maybe 7, and a ps of 4, max ipap of 12, and see how you do for a bit.

I think your starting 10/4 idea is going to be a surprise Smile

oh, and welcome to the club, I like mine... it's quieter than the 560 I had before it.
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#5
I don't know about PR machines and their various flex settings, but on a Resmed VPAP: EPAP + PS = IPAP. There's no EPR or flex involved. I'd suggest you start with EPAP Min = 6, PS Min = 3 and PS Max = 6, IPAP Max = 15. That will give you a range similar to your previous machine with a bit of room at either end of the range. Try this for a week or so and see how it goes. (I agree with diamaunt, EPAP = 4 seems pretty low).
DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
Default the other settings (Ti min and max, and the switch sensitivities). You should see "easy breathe" in the settings. Makes the transition from EPAP to IPAP more smooth. But, it will grey-out Trise. I find the machine does not capture some data in S or CPAP mode -- only in Auto mode.

(06-28-2014, 08:35 PM)DeepBreathing Wrote: I don't know about PR machines and their various flex settings, but on a Resmed VPAP: EPAP + PS = IPAP. There's no EPR or flex involved. I'd suggest you start with EPAP Min = 6, PS Min = 3 and PS Max = 6, IPAP Max = 15. That will give you a range similar to your previous machine with a bit of room at either end of the range. Try this for a week or so and see how it goes. (I agree with diamaunt, EPAP = 4 seems pretty low).

Huh -- can only have one PS.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
(06-28-2014, 08:35 PM)DeepBreathing Wrote: I don't know about PR machines and their various flex settings, but on a Resmed VPAP: EPAP + PS = IPAP. There's no EPR or flex involved. I'd suggest you start with EPAP Min = 6, PS Min = 3 and PS Max = 6, IPAP Max = 15. That will give you a range similar to your previous machine with a bit of room at either end of the range. Try this for a week or so and see how it goes. (I agree with diamaunt, EPAP = 4 seems pretty low).

the vpap auto doesn't have ps min/max, it's a fixed ps, unlike the adapt,

he can set epap min, ipap max and ps. (and trigger/cycle/ti min/ti max if he wanted to)

essentially, the ps IS epr, just more much more customizable... I bumped up my trigger and think I like it a little better.
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#8
(06-28-2014, 09:04 PM)justMongo Wrote: You should see "easy breathe" in the settings. Makes the transition from EPAP to IPAP more smooth.
easybreath is only available in S (plain bilevel) mode, not vauto mode. (fyi)
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#9
(06-28-2014, 09:24 PM)diamaunt Wrote: essentially, the ps IS epr, just more much more customizable... I bumped up my trigger and think I like it a little better.

diamount,

When you say that you bumped up your trigger did you bump it up from medium to high or from medium to low. What made you decide to try adjusting the trigger. Just curious.

Best Regards,

PaytonA
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#10
(06-29-2014, 04:21 PM)PaytonA Wrote: When you say that you bumped up your trigger did you bump it up from medium to high or from medium to low. What made you decide to try adjusting the trigger. Just curious.

I bumped it from medium to high,

[Image: trigger-cycle.jpg]

I felt it was a little slow on going from epap pressure to ipap when I'd start to inhale so I raised the trigger sensitivity.
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